Cardio-respiratory and critical care is 10% of our bank, about 15 items on a 150-item paper. It sits inside Medicine, which the SMLE weights at 30% and Qatar DHP at 47 of 150 items. The SMLE blueprint marks coronary artery disease, heart failure, asthma, COPD, pulmonary embolism, pneumonia and tuberculosis as mastery level 3. Most items ask for the next best step, so the skill is sequencing and knowing which guideline's threshold the stem uses.
Weight and where it sits
This is the first of three medicine domains in the bank, with endocrine, renal and gastrointestinal and infection, haematology and neurology. Together they make 30% of the bank, close to the SMLE's 30% and the roughly 31% implied by the DHP item counts. On a 150-item paper, expect about 15 cardio-respiratory items; that is a planning figure, not a published count. The wider picture is on the exam overview.
What is tested
| Cluster | Subtopics | Typical task |
|---|---|---|
| Coronary and heart failure | Acute coronary syndrome (STEMI, NSTEMI, unstable angina), stable angina and chronic coronary syndrome, heart failure (HFrEF, HFpEF, acute decompensation) | Diagnosis from ECG and troponin, first treatment, reperfusion choice |
| Rhythm and pressure | Atrial fibrillation and anticoagulation, supraventricular and ventricular arrhythmias, ECG interpretation, hypertension (diagnosis, treatment, resistant and secondary causes), hypertensive emergency | Rate or rhythm decisions, stroke prevention, drug choice |
| Structure and inflammation | Valvular disease, infective endocarditis and rheumatic heart disease, pericarditis, myocarditis, cardiomyopathy, cardiovascular risk and lipid management | Recognition from signs, prophylaxis, risk estimation |
| Thrombo-embolism | Pulmonary embolism and deep vein thrombosis | Pre-test probability, imaging choice, anticoagulation |
| Airways and lung | Asthma (acute and chronic stepwise management), COPD (diagnosis, exacerbation, long-term oxygen), community-acquired pneumonia and CURB-65, pleural effusion and pneumothorax, lung cancer and solitary nodule, obstructive sleep apnoea and respiratory failure | Severity grading, step up or down, disposition |
| Critical care | Sepsis and septic shock (first-hour bundle), shock states and ACLS, interpretation of arterial blood gases | Immediate management and interpretation |
Guideline points to hold
- Hypertension. ESC/ESH guidance defines hypertension as office blood pressure of 140/90 mmHg or more, and severe hypertension as 180/120 or more. The ACC/AHA 130/80 threshold is a different guideline. Do not mix them in one answer.
- Acute coronary syndrome. Aspirin 300 mg loading. Add a P2Y12 inhibitor according to ESC 2023, with ticagrelor or prasugrel preferred in ACS managed invasively. In STEMI, primary PCI within 120 minutes of diagnosis, and fibrinolysis if PCI cannot be delivered in time.
- Atrial fibrillation. ESC 2024 uses CHA2DS2-VA, which removes the sex category. Oral anticoagulation is recommended at a score of 2 or more and considered at 1. DOACs are preferred over warfarin except in mechanical valves and moderate-to-severe mitral stenosis. Older stems use CHA2DS2-VASc, with thresholds of 2 or more in men and 3 or more in women. The stem should name the version.
- Sepsis. Surviving Sepsis Campaign 2021: antimicrobials within 1 hour for septic shock or a high likelihood of sepsis, at least 30 mL/kg crystalloid in the first 3 hours for sepsis-induced hypoperfusion, noradrenaline as first-line vasopressor, a MAP target of 65 mmHg.
- Gulf angle. Rheumatic heart disease sits at mastery level 2 in the SMLE blueprint. MERS-CoV is covered in the infection domain but presents as a severe respiratory illness, so read stems with a camel exposure history carefully.
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Stems that cross systems
Breathlessness, chest pain and collapse are presentations, not diagnoses, and the stem decides which system it belongs to by the detail it adds. A patient who is breathless after a long flight points to pulmonary embolism, one with orthopnoea and ankle swelling to heart failure, one with wheeze and a trigger to asthma, and one with fever and focal signs to pneumonia. Build the habit of listing the three most likely causes from the first sentence, then letting each later detail eliminate one. The same method works for syncope, palpitations and cough.
Three typical traps
- Guideline drift on numbers. A stem gives a blood pressure and asks for a diagnosis or a target. If you apply a US threshold when the stem is European, the answer flips. Identify the guideline first, then read the numbers.
- Initial versus definitive step. In ACS and pulmonary embolism the question may be about what to do first, such as aspirin, oxygen only if hypoxic, or analgesia, not what the definitive treatment is, such as PCI or anticoagulation duration. Read the stem's task line before the options.
- Treating the number, not the patient. Anticoagulation scores, CURB-65 and risk calculators guide decisions, but a stem will add a detail, such as active bleeding, pregnancy, renal failure or a mechanical valve, that changes the answer. Look for the detail that breaks the default.
How to revise it
- Draw the decision tree once. For ACS, AF, heart failure and pulmonary embolism, write the first three decisions on one page and learn them by heart.
- Drill ECGs daily. Ten minutes a day on rhythm and ST patterns. Recognition speed is what you lose first under exam time.
- Do the ABG routine the same way every time. Check pH, then the respiratory and metabolic components, then compensation. A fixed order prevents the common error of explaining the wrong disturbance.
- Do 30 questions per subtopic cluster, then review the explanations. Use the study plan for timing.
- Revisit the guideline numbers weekly from the one-page sheet in high-yield topics.
For acid-base and electrolyte overlap with this domain, see the endocrine and renal domain, and for emergency overlap with sepsis and anaphylaxis, see the emergency domain.
Frequently asked questions
How many cardio-respiratory questions will there be?
Our bank gives this domain 10%, about 15 items on a 150-item paper. That is an editorial weight. DHA, DOH, MOHAP, OMSB and NHRA publish no weights, and the SMLE and DHP blueprints work at the level of Medicine, not by organ system.
Which cardiology topics does the SMLE rate highest?
The 2026 blueprint marks coronary artery disease and heart failure as mastery level 3, with asthma, COPD, pulmonary embolism, pneumonia and tuberculosis also at level 3.
Do I need to know both CHA2DS2-VASc and CHA2DS2-VA?
Know both. ESC 2024 uses CHA2DS2-VA, while older material and some stems use CHA2DS2-VASc. A well-written stem names the guideline year.
Which blood pressure threshold should I use?
Use the guideline the stem implies. ESC/ESH uses 140/90 mmHg for hypertension. The ACC/AHA 130/80 threshold is a different guideline, and our questions do not depend on it.
Are arterial blood gas questions common?
They are listed among the subtopics and the skill is transferable to renal and respiratory items. Learn a fixed routine and practise it daily.